Skip to main content
12:20 am
longer be able to appeal to young people and get them hooked for life. we know that the tobacco companies business model relies on getting young people hooked. in fact, 80% of young people are addicted before they turn 19 years old. 80% of the smokers are addicted before they have turned 19. and 99% of smokers were addicted before they turned 26. the reason tobacco companies have to target young people is because their older smokers keep dying. in fact half of noke smokers end up dying from smoking we know young smokers are most responsive to two things. they are responsive to cost and packaging. we have done a lot in the area of price by increasing the taxes tax, by reducing the number of duty-free cigarettes that athey
12:21 am
can bring into australia. we have listed nicotine on the pharmaceutical benefits gain. we have restricted advertising at point of sale. we have increased the graphic warnings on packets. we have seen bans on smoking in restaurants and so on. over the years, this combination of measures has made dramatic inroads in smoking rates in australia. in 1988, about 30% of people over the age of 14 were daily smokers. we have got that rate down to half that now. about 15% of australians still smoking. 15% is still too high. we have a target of getting that down to 10%. while we have won this battle today, the war is far from over. almost half of the original original people still smoke, and half die from smoking. we know a third of teenage moms
12:22 am
smoke when pregnant. so we have a lot to do, but today's victory is a great victory. >> also the government was pressed what support it is helping the wikileaks founder, julian assange. the foreign minister insists it is providing him with adequate support. >> senator. >> thank you, president. my question is to the foreign affairs minister. minister, in response to several parlors of metropolitan police in the house which houses the ecuadorian embassy in the night, quardoning of the street and threatening to close down the embassy, have you made referendum to the united kingdom to not violate the vienna -- foreign minister, i am
12:23 am
interested to know if any you we have made representations to the british government in this regard. >> the minister for foreign affairs. >> this is a matter between mr. assange and the upited kingdom. and the court case rising to this fashion, of course, is between mr. assange and the government of sweden. this morning the equadorian minister did say he would have an asylum claim. the outcome is a question for the united kingdom and australian governments. the australian government cannot intervene in the u.k. legal process.
12:24 am
we have no standing in the british courts. but the government does not -- >> senator ludlum has gotten to his feet. >> i appreciate the minister reading from a brief. the question i have is if we have made questions to the government? >> there is no point of order. the minister is asking the question, and the minister has one minute and five seconds remaining. mr. minister? >> the question is based on the assumption the building is being occupied by metropolitan police. i haven't been advised of that. to date there has been 62 representations made by the australian government about consular contact with mr. assange or his legal
12:25 am
representatives since legal proceedings commenced in 2010. now, according to information i've gotten from the government, no australian has received more attention in a comfortable space of time in terms of consular representation than mr. assange. this includes representations on his behalf for the governor of the united kingdom and the governor of sweden to obtain due process in current and future legal proceedings. >> and the highlights from the latest sitting of the australian parliament. i'm david speers in cambria. see you next time. >> see the first presidential gays debates wednesday october 3, live on c-span, c-span radio, and watch and engage.
12:26 am
>> next, a debate with candidates fofert u.s. -- for the u.s. senate in missouri. then michelle obama at the congressional black caucus. and then a discussion of medicare advantage program funding. >> tomorrow, mexican president calderon discusses u.s.-mexico relations and the consumer -- country's standing locally on the council on foreign relations. coverage begins at 9:00 a.m. eastern on c-span 2. >> we are trying to encourage our developers to think about what information they really need to make the app functional. so for instance if you are playing a game, do they really need to collect geo location information that will track the consumer if as aggregated and collected? it can collect the consumer as
12:27 am
she pass through the day and for all day. what information is needed to make the app fumpingsal? in other words, should access be limited? how long do you need to retain it? and when you are done with it, what are you going to do with it? >> one of the big problems is to look for -- they are looking for more and more people to move into this industry, creating apps, all that goes into it. basically that's the biggest problem, i think, that somehow we're in washington going to tell everybody how to do their business or how not to do their business. and we're a growing business. the only real fear was, you know, work force issues. the rest of it is nothing but optimism. >> smart phone apps monday 8:00 eastern on c-span2. >> missouri senator and congressman todd aiken
12:28 am
participated in a televised debate friday. the political report rates this race as likely democratic. press association. >> thank you phil and welcome again to the missouri press association debates. let me introduce to you today our candidates, we have to my left, republican congressman todd akin. in the middle, democratic senator claire mccaskill. at the end, libertarian candidate jonathan dine.
12:29 am
let me also introduce to you today our panel of journalist who will be joining me and asking questions today of the candidates. we have a student at the university of missouri, we have bill miller of the washington missourian and jeff fox of the independent examiner. now let me briefly go over the rules of our debate today. the candidates drew numbers in advance to determine their speaking order. they will each have two minutes for an opening statement. candidates will have the 90 seconds to answer each question with a 45 second rebuttal at the option of the moderator. i will ask the first question and then our panelist will take turns asking questions. at the end of the debate, candidates will have two minutes for closing debates. for the members of the audience, we ask
12:30 am
you to silence your phone and hold your applause. let's get started. we're read for our opening statements a congressman akin you're first. >> thank you all very much for allowing us to have this chance to talk about things that matter about our families and about our country. i'm an engineer. i served as an officer in the army and work for ibm where i met my dear wife of 37 years. we have 6 six, 8 grandchildren. thee of -- three of my sons went to the neal -- navel academy. as you can imagine, i have a great love for our country and for the american dream and the things that made us who we are. but my sense is, that things are not all right.
12:31 am
if you take a look at gasoline prices, they are double what they were a few years ago. food prices are up. for the fact is, the jobs aren't there and the numbers are much worse. we also have the $16 trillion of debt, a trillion plus deficit every year and all of these things are like little red lights on the dashboard telling you, something is not right. i believe that we have forgotten the secret of what made america such a special country. that is something which we see being destroyed right at our very -- right in front of our very eyes. we see a washington d.c., which got more and more red tape and bureaucracy and agency and executive orders and taxes and everything and they basically crushing freedom in america.
12:32 am
your choice in this election is either more freedom as i have voted for more washington d.c. it's your choice, more freedom or more washington. >> claire mccaskill? >> thank you to the press association. it is great to be here and thank you to both tawed and jonathan for being here today. this election will be a quite contrast for missourians not because we're at opposite ends. i'm in the middle. he's so far on the fringe. there have been many comments made in this campaign that congressman akin that i find unacceptable. it's his views that will be painful. i'm proud of my strong moderate record in senate where i have worked with many republicans to do important things. like cutting spending, like
12:33 am
banning earmarks, like cutting taxes over a trillion dollars for small businesses and working families. cleaning up contracting and protecting promoting american jobs. todd has worked closing with michelle bachmann, they pushes things that will harm missouri. on march 8, 2011, todd akin said i don't like social security. he's bone on in this campaign to -- he would raise the retirement age he would lower the benefit. on august 13, 2011, he said medicare was constitutional. since that time, he has in
12:34 am
fact voted several times to voucherrize medicare. it arm wrestle with them for coverage and whether their claims will be paid. i believe we can lower the deficit and debt but we will not do it, we should do not do it at the expense of these program programs for seniors. >> jonathan dine? >> welcome everybody and thank you for come out today. i want to give a big thanks for the missouri press association to host this debate. my name a jonathan dine and i'm a libertarian candidate for the united states senate. like many of you, i'm tired of the constant fighting of the republicans and democrats. beating the other team has become more important. america is now on the verge of a financial collapse and both parties are to blame with their wreckless tax, borrow and spend policies. neither party seriously about balancing the budget
12:35 am
or lowering your taxes or restoring your personal freedom. for as long as i can remember, republican and democrat politicians offering up solutions. higher and higher taxes. enough is enough. as a libertarian senator, i will stand up for your personal freedom, i'm socially accepting and tolerance. i'm also fiscalally responsible. i'm tired of the wreckless spending and the wreckless earmarks as your senator, i will vote no to wreckless spending, vote no to any legislation where spending exceeds revenue. i will advocate on the part of the balanced budget amendment. the government should live within its means just like the people of missouri. supporting my candidacy means supporting a lower tax level across the board. we do not need politicians
12:36 am
telling us what we can love, what to do with our own money and body. be libertarian with me on november 6th. >> thank you, it is now time to turn to question segment. i will ask the first question and it will go first to congressman todd akin. the missouri senate race was thrust into the national spot light after comments congressman akin raised. to what extent this comment matter and to what context do you think voters should consider it on election day? >> i answered this question repeatedly. i don't believe that this election overall is about talk. but it's really about two visions of what america is. are we going to go down the path of greece that constantly has a bigger
12:37 am
government and taxing more? are we going to go the path of america has always been on a path where we allow freedom, where we allow the american dream to flourish where we don't crush it under the burden of washington d.c. that's the choice of two different americas. it seems to me what a senator should be doing is taking the common sense that you and i know that's here in missouri and taking that to washington d.c. that's what this election is really about. it's not about words. it's about two different voting records that are the exact opposite. claire can say these a 50 percenter when you vote 98% of the time with obama,
12:38 am
give her credit to that. >> i think congressman akin's comments opens the window to his views for missourians. he has apologizedder those comments but they say a lot about how he views things. that's where missourians need to pay attention. i believe a rape victim should be allowed to have a emergency contraception in order to avoid pregnancy. todd akin does not. i believe his view is extreme and out of the mainstream for most missourians. there's other extreme views, he wants to abolish the minimum wage, he wants to do away with student loans. think what would happen to columbia, missouri if the only kid who could get a
12:39 am
college loans, the only kids that can go to college with rich kids are the super star academics. he wants to privatize medicare, privatize social security, he wants to do away with student lunch program. he is one of the handful, think there were four or five members of the united states congress that voted to eliminate child nutrition program. the vote was something like 416-5. i don't think that's the mainstream compromise willing fix problems and attitude that's we need to send to washington. it's not what he said that is the problem, it's what he believes that's the problem. >> jonathan dine? >> like many of you, i found akin's comments insulting and insensitive to victims of rape.
12:40 am
i believe it shows that career politicians have grown too secluded in washington and have forgotten what life is like outside of politics. i was astonished to find that akin's sits on the science committee and he fails to understand 8th grade biology. it illustrates the point that we have 535 people to regulate everything but produce nothing. we really need to step back and understand that his views and the views of an individual shouldn't be regulated by the government. he speaks for smaller government, yet he wants to push government morality on other individuals because they choose a different way of life. as your senator, i think the issues of abortion are really a wedge issue to take away and distract from the important issues like balancing the budgets and
12:41 am
ending the wars and destroying your personal freedom. step back and take a look at the important issues. >> congressman akin, there were several characterizations of your position there. would oatlike offer a chance of rebuttal? >> there were a few words there. let's start with a couple really basic things. if you don't believe the federal government should do everything, it doesn't mean you don't believe in it. the question do you want the federal government to take over everything that's important. i don't think so. my comments about student loans why don't we leave it the way it was a couple years ago where private lenders can be involved in student loans. or school lunches. is it okay to say maybe that should be done by the state of missouri. does it mean you're against school lunches. mind set here is the federal government has to do everything for us all the time. you want to talk about medicare, let's talk about votes. let's talk about somebody who voted to take
12:42 am
$700 billion out of medicare and then wants to crusade as the big hero of medicare. i don't understand that. >> claire mccaskill, he raised the issue of you wants to take $700 billion out of medicare. >> first, no one is saying private lenders can't lend to students. they can do that now. they just didn't want to do unless the federal government was backing them up and making a cut. all we did say take out the middle man who's taking a cut with no risk. i would thing congressman akin appreciate that. no one is keeping banks from loaning to students. secondly on the medicare cuts, this is the biggest swapper of this campaign season. it is unbelievable to me that congressman akin will vote time and time again for same medicare savings. he knows that the ryan budget took that same
12:43 am
saving, you know what they did with the saving, they gave another tax cut to kim kardashian, they gave another tax cut to lebron james, instead of what we need to do with the money, that is strengthening the medicare program. >> we must move on to the next questions here. the next question goes to senator claire mccaskill. >> in the past 11 years, average prices for undergraduate tuition room and board at public colleges have risen 42% according to the u.s. department of education. what is the specific solution to the declining affordability of education? >> i will tell you it's not to eliminate the department of education. that's what congressman
12:44 am
akin wants to do. what we did is we took the middle man out of the student loan and took that cut that they were making with no risk. we took that money and increased the amount of the pell grant which allows more kids to get to college. this is the land the opportunity. this is where we believe that anybody can do anything and personal freedom is very important but to get to that next lad dar, there's a lot of families that can't get their kids to college. i don't want to shut that door for them. it's important, i think, we keep the pell grants in place. it's a big contrast between me and congressman akin. we have to pay attention to student tuition. it is i think, bad that we are not investing more in higher education at the state and local level. unlike many others, we should raise the cigarette tax.
12:45 am
i'm embarrassed that the cigarette tax is the lowest in the country. our cigarette tax is 17 cents a pack. we could raise it by almost a dollar and still be the cheapest cigarettes in the midwest and have that money go directly to help with higher education. >> jonathan dine? >> education should be getting cheaper, not more expensive. with cheaper computers and electronics, i would like to open up the door for entrepreneurs to come into education. our education system comes too rigid. we don't need to look at why the reason tuition prices are raising. i believe easy to secure government loan have actually increased the price of college with kids receiving more money college institutions have increased the price. if there wasn't as much money being lent out, college campuses would be empty and will be forced to lower the price of tuition.
12:46 am
greed has played a big price. i would like to work on investing in education. i think it is something that's important but it should be done at the state and local level. not the federal government. >> todd akin. >> thank you for a good question here. this is one that really affects a whole lot of people. there was a young man in my office the other day, he said i'm glad i'm out of college but i do owe $100,000 and i'm looking for a job. i thought, how hard it is to try to save $100,000 for that undergraduate degree. how many years it's going to take to try to set that money aside. this is a big problem and it's affecting a whole lot of people. but, the question is then, why is it that college education is just spiraling up in its cost? part of it is because of the government. when the government keeps
12:47 am
get into things, it affects the marks place. what's happening is, the government is giving these loans and encouraging the prices to go up and where does that stop? we're putting people into an incredible vice by the government using more and more money to do things, killing jobs and then facing kids with a completely impossible choice. you want an education but you can't pay for it. this is an example of us doubling down on failure when the government gets into things, a lot of time, it messes them up in the impact example is freddy and fannie and the entire economic mess we're in which was created by the government deciding to get involved in home mortgages. how many more things do we want to inject the government in. they're the ones driving this cost. >> our next question will come from bill miller and go to jonathan dine.
12:48 am
>> the u.s. postal service is very important to most of the people in this room today. it is now trying to go into a program that would compete and be unfair to newspapers. in many cases, newspapers the largest customer for the post office in the community. what i like to know is, what is your position on this issue and the other issues of closing rural post offices and eliminating saturday delivery. what's your position on this? what would do you in the senate to help rural newspapers and community newspapers that depend on the postal service? >> like many of the things run by the government, the postal office is one of them that's very inefficient. i have a friend who works for the postal office as mail carriers. he gets
12:49 am
four days straight, ten hours a day. every time he's needed, he gets more overtime. the federal government instead of hiring postal service, will prefer to pay double time or time in a half to one individual wasting more money instead of hiring more people and creating more jobs. i think that the postal service should cut cost if it wish to remain around. maybe increase the price of a stamp and i would be in favor of closing postal service on saturday. we are in a fiscal crises. we do need to make tough choices. if one of them is cutting back on some of the services, we can wait until monday to receive our mail. >> todd akin? >> well, let me say first of all, postal office is something that's constitutional. government suppose to be doing that. all of you have grown up knowing the postman. you he he's going to bring a letter from somebody
12:50 am
special. you expecting a package you order and you're waiting and hoping the postman bring it. it's part of american tradition. there is a principle involved here and that is i think the best way when the government is doing something, is to have each thing set on its own base. that way we all know that we're not transferring money from one thing to another thing or covering up something. i believe that the postal service needs to be following that kind of principle, and that is the amount of money that's being charged in stamps and the service they provide needs to match the cost of providing those services. that's the best way to solve this and all kinds of other questions. that's one of the reasons why for instance we have gasoline tax. because gasoline tax pays for the the roads. i believe that's probably the best principle overall to deal with the questions and post office. >> claire mccaskill if >> i'm going to try to
12:51 am
quote todd akin exactly on this. he said, we can keep raising the prices, if they get too high, the private sector can take over. i disagree. it is in the constitution. we have had the finest and the most reliable and most comprehensive postal service in the world. they have cut billions in expenses over the last several years. they have shrunk their workforce. what they've been required to do is prefund their pensions and healthcare for 75 years. no one in the private sector is required to prefund their pensions and healthcare for 75 years. no one in the governmental sector except the post office is required to do that. it's got them into a cash flow problem. we have to uncuff them and allow them to be entrepreneurial when it comes to the growth area postal service. i will tell you, mr. miller, you know this and many in this audience know this, a rural post
12:52 am
office is more than bricks and mortar. i group in houston and lived in missouri, i still remember where the post offices where in those communities. it's a place the community came together and felt united. six day delivery is important. rural missouri for senior that's need their medicine. the bill is bipartisan. it saved money. it is in the senate. congressman akin is part of the gridlock that won't pass it. i would ask you congressman akin go back to washington, stop campaigning and help us pass the postal bill. >> congressman akin would you like rebuttal time? >> first of all, i heard what the answer was. well, if you can't make the thing work, we'll just take money from somewhere else to help pay for it. i don't know that's a very responsible solution. the idea of the fact that
12:53 am
the rural post offices are important, i never said they weren't important. think they're great. there has to be some kind of fiscal responsibility. it's not responsible to take all the stuff you want and we're going to somehow make money up here. that's where we're going and because of policies like that and thinking like that, from claire mccaskill, that's why we're running over trillion dollars that we don't have trying to spend it every year. you want to talk about gridlock, let's talk about the senate. it is completely stuck. hasn't done any budget for 1200 dayses. >> senator mccaskill. >> let me tackle the budget quick. this entail fiscal responsible to save the post office. it doesn't take any tax dollars. it continues to make the post office reliant on their income. on the the budget,
12:54 am
congressman akin knows last summer instead of passing a resolution the appropriators absolutely ignored. only way you spend money in washington is with an appropriations bill. it's not the budget resolution. all the budget resolution does is advisory and appropriators usually ignore it, as todd knows. we passed a law last year that limited the size of the budget for two years. it actually says in the law, if you go to mccaskill. you can read it. we want to keep that spending down. this is a political talking points and it's unfair one. >> it time for our next question. will come from jeff fox go first to congressman todd akin. >> estimated 10,000 baby boomers turn 65 everyday. that has dramatic effects on medicare. what is the best approach to put medicare on a
12:55 am
permanently secure financial footing? >> putting medicare on a firm financial footing is going to first of all, involve repealing obamacare. look, let's take a look at what obamacare does to medicare. first thing it does is it cuts $700 billion out of medicare. it's pretty hard to say you're in favor of medicare and cut 7er hundred billion dollars out of it. let's take a look at the second thing it does which is even worse. it creates a 15 person board that will effectively be the people deciding who gets medical treatment and who doesn't. this is rationing. this is government rationing. if you want medicare to work properly, what we need to do is get away from the concept that the government has to do everything. in medicare right now, the government sets the prices of the cost of everything
12:56 am
in medicine. we don't want the government setting prices. what in fact, we should allow series of people offer medicare to seniors and let them choose which one they want. it's a whole lot better to choose from different providers. i think we need to get rid of the price setting which never works. you can go back to 1600 in england, it never works. the government shouldn't be price setting. just allow providers to offer the service to seniors so they have choices. thank you. >> claire mccaskill? >> the affordable healthcare act known as obamacare, does not cut one dime in medicare benefits. it realizes savings by taking some of the big profits away from the insurance companies, corporate welfare they were making off medicare advantage. it lowers some of the reimbursments to hospitals but it depends on the fact
12:57 am
we will have more paying customers. by the way, once again, it's the same $700 billion that he voted for the ryan plan a couple times. closes the donut hole and it stands solvency of medicare for eight years. what i didn't hear was his plan. his plan is to privatize medicare. he wants to give seniors a voucher and once you spend your voucher you're on your own. if the premiums go up, you can't afford it, you're on your own. how do we fix it? there's a couple things we got to do. one we need to do some aggressive means testing. i know political season and i'm not suppose to say we will do anything like that. i believe in it. i don't think we can afford to buy donald trump's prescription drug. we can means test some of the medicare program and enact some of the savings program that are working.
12:58 am
st. johns hospital in springfield, took their medicare population and with quality control and customer satisfaction, they were able to reduce $17 million in medicare payment that's were owed. as a result, they got a bonus of $4 million. that's what we need to do in a capitalistic system. spending less money rather than incentivizing more treatment. >> jonathan dine >> like many of the government entitlement programs, medicare, medicaid are all coming to a cusp. they are coming towards a financial cliff where we will not going to be able to save them. i would propose block granting the states money based on population to deliver healthcare for seniors and people over 55. i feel that the states will be more closer to people of
12:59 am
the state actually more listen to the legislator and provide you better service. any time you expect the government to manage your money efficiently, we can look at the record of spending money wrecklessly with mismanagement. i feel had we really need to make tough choice or we will all be left with nothing. >> congressman akin and senator mccaskill privatized medicare. would you like to respond to that? >> the idea is that the senior has a choice in medicine. that's the idea. instead of having one size fits all, which is the big government solution. we're trying to allow choices. look, there's o thing in medicine that i don't like. that's when an insurance company gets between the doctor and patient. one thing that works, that's when the federal government gets between the doctor and patient.
1:00 am
i don't support and neither to 71% of the missouri public support the bright idea of having the efficiency of the federal government and the compassionate the i.r.s. running our healthcare. i'm opposed to that. i voted 30 times to repeal it. when you get to the senate, i will be the one to vote to make sure it gets repealed totally. >> i think it's important to remember that there is a lot of misinformation about this bill. there's not a government plan in it. it's all private insurance. there's good things in it. you need to remember what congressman akin wants to repeal. he wants to repeal the ability of insurance companies. we wants to repeal kids being able to stay on their policy in their 26 years old. he wants to repeal on focus on prevention. he wants -- i think if
1:01 am
missourians will give this legislation a chance, there going to be pleasantly surprised. >> the next question comes -- it goes to claire mccaskill. >> what current issue in federal government you feel least to address as u.s. senator and how you might prepare yourself to deal with it? >> i'm first? >> you are yes. >> i hope i am prepared since i have been blessed to serve in the state of missouri for six years. the thing that prepares me the most day in and day out is my focus on being here in missouri and traveling missouri.
1:02 am
1:03 am
[captions performed by national captioning institute] [captions copyright national cable satellite corp. 2012] the thing that prepares me for this job is just being from the ground level. i understand that have an open mind and listen to the people of the state. when i propose legislation, i bow represent the people of missouri. when it -- i will represent the people of missouri. one of the biggest problems in america are career politicians. we need term limits across the board. congress should be a revolving door of fresh ideas.
1:04 am
>> todd akin. >> no matter how much you work and prepare and study, when you are working in congress, you'll get issues that you do not know that much about. we run into that all the time. our job is to get to speed on the issue and tried to render a good judgment. the things most difficult are the ones you are not quite sure what the answer is when you first hear it. on the wall street bailout, we were approached and henry paulson looked like he was going to disintegrate. the whole world economy is going to collapse unless you give this $700 billion. we had to make a decision. he gave us to lousy choices. the common sense of missouri says look for a third solution. once you figure out what is going on, you find out there is
1:05 am
a principle behind all things. you have to focus on that principle, but the politics aside pat and do the right thing for the people of our state. -- put politics aside and do the right thing for the people of our state. our job is to find the principle, do the right thing, and a year or two later, the politics is gone. we could have changed accounting rules and fixed the problem without spending $700 billion. >> our next question will come from bill miller. >> are you satisfied with this country's foreign policy in dealing with iraq and afghanistan? if you are not satisfied, what you think president obama should consider in a way of changes?
1:06 am
>> i am not satisfied. as a libertarian, i seek a world at peace with other nations. i look to thomas jefferson's quotation for inspiration. peace, converse -- commerce, -- america should stop acting as the world's policeman. i do believe in a strong national defense, but the optimum board is defense, not offense. we do not have the money to continue the wars. our money could be more wisely spent here at home. >> todd akin. >> it is important to have a foreign policy to start with. you have to have some basic principles, the guidelines. that needs to an acute --
1:07 am
including iraq, afghanistan, a whole lot of other countries as well. the problem is we have not had that. what it seems like the vacillating policies we have almost punished our friends and helped our enemies. we decided to turn our backs on two of our allies, the czech republic and poland. we had plans to build missile defense. we gave that is a concession to russia. how much has russia helped us with iran? how much has russia helped us with the situation in afghanistan? giving special attention to chavez and turning our back on netanyahu when he wanted to meet with the president, the sending of mixed signals is very destructive to foreign policy. in the case of egypt, for instance, we talked a little bit about that in a press release. this is a country that should
1:08 am
be protecting our embassy. while we give the money? let's withhold any money for egypt until they start acting like a nation, protect our embassy, and start not fundamentally consulting us by built -- by burning our flags? >> claire mccaskill. >> the war in iraq was mississippi. when i went to washington i went with the eyes of an auditor. harry truman is spinning in his grave over what went on in iraq. congressman akin not even go to require competitive contracts in iraq. i helped establish the war contacting commission when i got to washington. no one had paid much attention to this. we found $60 billion -- three years of the entire budget that
1:09 am
almost went up in smoke in waste, fraud, and abuse. no one was minding the store. we have begun to clean that up. in afghanistan, i support the mission of training police and army, but what we are doing in turn up -- is wrong. we're doing the same thing in afghanistan that we did in iraq. investing in highways, power plants, water projects that they cannot maintain. they cannot afford to sustain, and they're getting blown up or not used because they did not have the expertise. we need to pull out -- pulled out and the structure money out and bring it back to the united states of america. we need a big bridge near washington, missouri. we need more highways and missouri. we need dam projects on the missouri river.
1:10 am
i disagree with that. >> the center mention something about your position on competitive contracts. did you want to respond? >> i believe competitive bidding is a good thing. what you have going in iraq is pretty interesting. you had people who were terrorists. anything anybody did, they would load up or shoot anybody associated with it. -- they would blow it up or shoot anybody associated with it. the attacks on the idea of roads in afghanistan, the big economy and afghanistan is heroin. her win, you can put on a motorcycle -- heroin, you can put on a motorcycle and take somewhere. i have a kid serving in afghanistan. i have a kid almost killed in iraq. i understand the cost of what we are doing. i want to do it in the right
1:11 am
way. >> did you want an additional 45 seconds? >> there was nothing about the contract and in iraq that did that require a competitive luck. there was nothing about that contracting. they finally did begin to compete for these contracts. abramoff diagramming hand towels to dry up the cost -- they were model granting -- that was the contract. the famous halliburton contract that they completely took advantage of the american people on, this was a bill that would require competitive bidding and the congressman voted no. >> the next question goes to todd akin. >> the country cut the federal
1:12 am
work force through attrition and freeze pay, close overseas military bases, cap spending at home, raise the gasoline tax, curtail the mortgage interest deduction, raise the payroll tax for social security, reduce entitlements as well as farm subsidies and civilian and military pensions. it recommended a lower system of taxation. why hasn't this become at least the beginning of a serious discussion about reducing the federal deficit? >> it was the starting point and there were a lot of good ideas in that particular commission. what we really stuck with -- ultimately, you have to put the whole thing into a budget to make it work. you have to balance those different elements and say, what is a reasonable approach? it is all but what -- like what if -- it is a little bit what
1:13 am
like families have to do. the budget has been set up for a vote and the budget has passed. was the budget i would have written? no, it was not quite as conservative. it was still a reasonable approach that puts us back on track to recovery. those budgets, of course, go where? to the senate. what happens when we send bills to the senate? they die. the budget saw in the senate and died. -- sat in the senate and died. that is the reason i am running for the senate. the senate cannot get anything done. it is the fed's rule of law that we are supposed to have a budget every year. i do not think the debt ceiling increase and another 10%, the
1:14 am
sequestration of defense, is not an excuse to do and what the law says. >> i agree with the congressmen that the proposal had some good ideas. we need to work off that framework. that was the framework the president and john boehner are working on when they got in the agreement last summer prior to his passing a budget into law. they were going to try to move $4 trillion of debts off the books. the tea party shut it down. we are working on a bipartisan basis in the senate every day to try to cobble together a plan that will reduce 4-$5 trillion of debt. i am part of that group. we need to reduce mortgage interest. i do not believe anybody buys a second, because of the mortgage interest deduction. we should look at whether we
1:15 am
should take a haircut on charitable deductions. we need to look at cutting farm payments. in fact, we did. we stopped all direct payments in the farm bill. we saved $23 billion in spending in a bipartisan farm bill the. what is more important for 70 in missouri than a farm bill? -- for 70 in missouri than a farm bill? -- for certainty in missouri than a farm bill? they did not even take it up to vote on it. that is the kind of gridlock we do not meet in washington. >> jonathan dine. >> i agree with a lot of the ideas and the commission, except for the gasoline tax.
1:16 am
americans already pay enough at the pump. we should have really nice roads for that much money. it does not go far enough. a lot of those things were not implemented because of something -- political cowardice, afraid to take on the real issues because they are campaigning, they're worried about reelection. we do need to make some serious choices if we do want to save what we have. it takes someone who was willing to say no to reckless spending, say no to corporate interests. >> todd akin, there were some issues raised about the farm bill. would you like a rebuttal? >> i keep hearing that we passed a budget in the senate. we have not passed a budget in
1:17 am
the senate in 1200 days. increasing the debt ceiling is not the same thing as a budget. increasing the debt ceiling, we do it over and over again as though we can just keep spending money. we cannot do that. that included and what resulted of -- and the sequestration, a second time% cuts in defense. panetta was asked, he is the ceo for terry of defense appointed by obama -- he is the secretary of defense appointed by obama. this is like shooting yourself in the head. it is not a budget is a disaster. >> read the bill. if he will read the bill, he will find the language specifically that says, this act shall serve as the budget
1:18 am
resolution for the fiscal year. this act shall serve zero as the budget resolution and it lays out the next year. you can read the bill and you can read the budget in the bell. go on my website and you can read it. guess what happened this year. the appropriators followed it. we cut direct payments, which was hard for many farmers to swallow. it was a hard vote in the senate. the farm bill is essential to missouri. we need to get at the work of getting the farm bill done. >> jonathan dine, did you want 45 seconds on the deficit? >> i am ok. >> this will have to be our last question. >> the trust for america's health -- researchers estimate
1:19 am
the projected increase in obesity rates will cost the united states $550 billion between now and 2013. what policies, if any, do you believe the government should adopt to prevent rising health- care costs caused by obesity- related diseases? >> this is a place that the government should keep their big nose out. i do not think the government needs to be telling people what they should eat or what they should drink. i understand it is a struggle. i am a woman in her 50s, i have seven sizes of clothing in my closet. i go from one end to the other. tried to set a good example, you know, speaking out about it like michelle obama has done, considering the importance of physical activity for our children, making sure we support and promote that in ways that are advisory only and not
1:20 am
requirement. also paying for prevention, making sure people can go see their doctors and learning about the dangers of diabetes. if we can bring down diabetes in our adult population by just 10%, it is amazing what it does to the cost curve of are debt and deficit. i would not be someone who thinks the government should get in the business of telling people what they should eat or drink. >> jonathan dine. >> the top five leading causes of death are all related to diet and lifestyle. they are all preventable. diet and exercise can make a big difference. i've been a personal trainer for 15 years. i help people motivate themselves. it is something that anybody can do at any age, but somebody needs to be a role model. the government should make incentives.
1:21 am
it is the number one drain on our health care system overall. we do need to have some positive reinforcement instead of negative reinforcement. obesity does kill more people than war, murder, crime, drugs, and everything else combined. if that is not a problem with the government should set a role model, i do not know what is. >> todd akin. >> all of us have things in our lives that are challenging. for some people, obesity is one of them. all of us are people. all of us have to try to manage those things and try to do the best pecan. -- the best we can. when the government starts to overstep and there are problems with jobs and all kinds of stresses, these problems become a lot worse.
1:22 am
i agree, this is the first time i've agreed with claire, this is not something the government should do. the federal government is telling you what kind of light bulb you should buy, i am glad there is something the federal government does not have to do. this is part of being americans. this is part of living the dream in america, that we can challenge ourselves. i think we also have to have a love for each other. we are all americans, we are all god's children. we need to give people a hand when they needed or some encouragement. this is one of a whole series of things that put in the category of self-government. the way that we run our own lives responsibly.
1:23 am
this is what has made america strong, we're good at doing that. >> that is the end of our question and answer session. it is now time for our closing statements. each candidate gets two minutes. >> america that is an absolutely unique and great country. sometimes we forget. we fought two world wars, we have next no territory, crowned no kings, and then we voted to tax ourselves to rebuild our enemies. how often has that happened in world history? we have the oldest written constitution. this is to we are, we are americans. what is the secret of america's greatness? i would believe that it is
1:24 am
pretty well captured by jefferson when he said, we believe there is a creative art who gives us life and liberty and pursuit -- a creator who gives us life and liberty and the pursuit of happiness. for you to have the liberty of free speech, to be able to go vote or to keep the things you earned and the pursuit of happiness, the essence of the american dream, that every single one of us are different, we are all equally important and each of us can go after what effort did is we have in our hearts to do. -- bill after whatever it is we have in our hearts to do. we follow those dreams and america has been built long dream at a time. that makes sense to we are. that is being threatened. and destroyed by people who are building washington, d.c., not protecting life, not protecting
1:25 am
liberty, taking so much people -- do you want more washington and big government or do you want to protect the american dream? god himself intended us to have life, liberty, and the pursuit of happiness. thank you. >> we have a choice. a choice between two candidates that have a much different view, but also the choice of whether we look back and blame or whether we look forward and fix. todd akin loves america and so do i.. todd akin believes america is unique and so do i.. but we have a different view about how we get to that shiny place on the mountain. we need certainty for our business community. do we get it through gridlock or do we get through compromise? i am very proud that i am part of a group in the senate that
1:26 am
believes in bipartisan compromise. i have stood up to my party and work with republicans to move the ball forward on tough compromises that make a difference. he is part of the gridlock. where is the farm bill? where is the postal bill? where are the bills the tea party is trying to shut down because they refuse to allow them to go forward? i've worked with a long list of republican senators. all these are things i have worked on with republicans to cut spending and to make are spending more responsible. the congressman wants to go back, he wants to go back to the same policies that created this mess in the first place. he wants to go back to a policy were all you have to do is to a another tax cut for the wealthy and everything is going to be
1:27 am
fine. no rules of the road for the greed of wall street. cuts in veterans benefits, give another tax cut to tom brady, eliminate student allowance, but give another -- privatize social security and medicare and but more cost on the backs of seniors, but give another tax cut to the wealthiest will peak of america. i do not think we have to do that. let's go forward together and fix it. >> jonathan dine. >> the federal government has exploded in size. no area of your life, your business, or your wallet is free from the meddling of politicians. it does not have to be this way. you could keep more of what you earn. it would be easier to start a new business, building new home, and fuel real economic growth. we need more ordinary americans to stand up and take an active role in government.
1:28 am
the political system would be better off if more credibility was given toibertarians. representre likely to a combination of views and think outside the box. it is time we break up some of the stagnation of the two-party system. i come to you as a concerned american citizen who is worried about the direction of this country. i am worried about the uncontrollable debt, the endless wars, i am worried about the erosion of our civil liberties and personal freedoms. i am not a fine-tuned polish politicians like my opponents, but i do have -- polished politicians like my pundits, but i do have genuine qualities. if you do support me, you'll be supporting lower tax levels and more personal freedoms across the board.
1:29 am
i promise to keep the republicans out of your bedrooms and the democrats out of your wallets.
1:30 am
>> thank you for having me here tonight. i want to congratulate this year's phoenix winner awards. holder, brown, gant, and lucas. thank you all for your outstanding contributions to our nation, and we look forward to hearing from you all later on this evening. i also want to take a moment to note the passing of a true leader in this caucus, conlman donald payne. the congressman was a distinguished member of congress, a visionary chairman of the c.b.c., and his presence is sorely missed. and finally, i want to recognize all of the c.b.c. members past and present who are with us here tonight. you-all are part of a proud tradition, one that dates back
1:31 am
not just to the founding of this caucus, but to the beginning of so many improbable journeys to the halls of congress. take congressman john lewis, for example. he was the son -- yes, indeed. [applause] he was the son of share croppers. as a boy yearnig to become a preacher, he gave impassioned sermons to the chickens on his family farm. and then there is congressman louis stokes who was raised by a widowed mother in cleveland's public housing. he served in the army during world war ii. and although he fought under the same flag, he still had to eat, sleep, and travel separate and apart from his fellow soldiers. then there is congressman
1:32 am
barbara lee who almost didn't make it into this world. when her mother was in labor, the segregated hospital refused to admit her. they didn't agree to care for her until hours later when it was almost too late. but from so many unlikely places, members of this caucus rose up and lived out their own version of the great american dream. that is why they came here to washington. they came because they were determined to give others that same chance. they were determined to open that doorway of opportunity even wider to those who came after them. they came because they believed that there is no higher calling than serving our country, no more noble a call than that of our fellow citizens.
1:33 am
now, this work wasn't always easy, especially when members of are caucus faced challenges they could not imagine. for example, back in the mid 1970's, congressman ron bellums was appointed to the -- as was congresswoman schroeder. displeased about having both a woman and an african-american in the committee at the same time, he awarded just one seat and he forced the two of them to share it. he said, let's not give these guys the satisfaction of letting them know they got under our skin. let's sit here and share this chair like it is the most normal thing in the world.
1:34 am
he have they have been fighting for jobs and health care. standing up for the least among us every day and earning the proud distinction as the conscience of congress. that is the legacy of this caucus. that is the legacy i want to talk about. now, back when our great grandparents were riding that underground railroad, back when john lewis was marching across that bridge in selma, and jim cliborne was sitting in jail, the injustice was written in big bold letters on the face of our law. while we may have had differences over strategy, the battles we needed to fight were clear. we knew we needed to end
1:35 am
slavery. we knew we needed an amendment to our constitution. to end segregation, we needed the supreme court to overturn the lie of separate but equal. to reach a ballot box we needed congress to pass the voting rights act. so we moved forward, and we won those battles, and we made progress that our parents and our grandparents could never have dreamed of. but today, while there are no more whites only signs keeping us out, no one barring our children from the schoolhouse door, we know that our journey is far, far from finished. [applause] but in many ways, the path forward for this next generation is far less clear. what exactly do we do about children who are languishing in crumbling schools? what about kids growing up in neighborhoods where they don't
1:36 am
have opportunities worthy of their dreams? what about the 40% of black children who are overweight or obese or the nearly one in two who are on track to develop diabetes in their lifetime? what court case to we bring on their behalf? what laws can be passed to end those wrongs? you see, today the connection between our laws and our lives isn't always as obvious as it was 50 or 150 years ago. and as a result, it is sometimes easy to assume that the battles in our courts and in our legislatures have all been won. it is tempting to turn our focus solely to what's going on in our own lives and in our own families and leave it at that. and make no mistake about it, change absolutely starts at home. we know that. it starts with each of us taking responsibility for ourselves and our family. because we know that our kids
1:37 am
won't grow up healthy until our families start eating right and exercising more. that's on us. [applause] we know we won't close that education gap until we turn off the tv and supervise that homework and serve as good role models to our own kids. that's on us. we know that. while we certainly need to start at home, we absolutely cannot stop there. because as you all know, better than just about anyone, our laws still matter. much like they did 50, 150 years ago. our laws still shape so many aspects of our lives. whether our kids have clean air and safe streets or not. whether we invest in education and job training and truly focus on the urgent challenge of getting folks back to work or not. whether our sons and daughters who wear our country's uniform get the benefits they have earned or not. see, these are the types of
1:38 am
decisions that are made by the folks in our city halls and our state legislatures, by folks in our statehouses and our congress, and yes, in our white house. and who is responsible for collecting those public servants . who is ultimately responsible for the zigs they make or don't make. we are. that's our job. as citizens of this great country, that is our most fundamental right, our most solemn obligation, to cast our ballots and have our say in the laws that shape our lives. [applause] congressman lewis understood the importance of that right. that's why he faced down those heroic -- he faced heroically those billy clubs.
1:39 am
as he put it, your vote is precious, almost sacred. it is the most powerful nonviolent tool that we have to create a more perfect union. [applause] but today, how many of us have asked someone whether they are going to vote and they say, no, i'm too busy, and besides i voted last time. or it is not like my vote is going to make a difference. see, after so many folks sacrificed so much so we could make our voices heard, too many of us choose not to make our voices heard. but when we are tuning out on election day, other folks are tuning in. other folks are taking politics very seriously. and they are engaged on every level. they are raising money. they are in constant dialogue
1:40 am
with elected officials. and understandably in the face of all that money and influence, it can standard to feel like ordinary voices can't be heard. like regular folks just can't get a seat at the table. but we are here tonight because we know that simply is not true. [applause] time and again history has shown us that there is nothing more powerful than ordinary citizens coming together for a just cause. i'm not just talking about the big speeches and protests, i'm talking about everything that happened between the marches, when the speeches were over and the cameras were off. i'm talking about the thousands of hours that people like dr. king and so many of you spent stratjiesing in cramped offices late at night. i'm talking about the folks in
1:41 am
montgomery that organized car pools and gave thousands of rides to perfect strangers. those who walked miles on aching feet. i'm talking about the volunteers who set up drinking fountains and first aid stations on the washington mall, who made 80,000 bag lunches for folks who marched on that august day. i'm talking about the tireless, relentless work of making change. you know that door-knocking, meeting planning kind of work. that is the real work of democracy. [applause] you know, what happens during those quiet moments between the marches. that is how we carry on that precious legacy we have inherited. by recommitting ourselves to that day-to-day work that has always paved the way for change in this country. so that means being informed.
1:42 am
even more importantly, it means showing up to vote. and not just every four years, in every election. [applause] as the great congresswoman shirley chisholm once said, you don't make progress by standing on the sidelines. it is the first three words to the preamble of our constitution, "we the people." and over the past three centuries so many men and women toiled and sacrificed so that every last one of us could be included in that "we." and today we owe it not just to ourselves but to them to exercise the rights they fought and died for.
1:43 am
so when it comes to casting our ballots, it cannot just be, we the people who have time to spare on election day. it can't just be we the people that really care about politics. or we the people that happen to drive by a polling place on the way home from work. it must be all of us. that is our birth right as citizens of this great nation. [applause] that fundamental promise that we all get a say in our democracy, no matter where we are from, what we look like, or who we love. we cannot let anyone discourage us from casting our ballot. we cannot let anyone make us feel unwelcome in the voting booth. it is up to us to make sure that in every election every voice is heard and every vote is counted. that means making sure our laws
1:44 am
preserve that right. it means monitoring the polls to make sure every eligible voter can exercise that right. [applause] and make no mistake about it, this is the march of our time. marching door-to-door, registering people to vote. marching everyone you know to the polls every single election. see, this is the sit-in of our day, sitting in a phone bank, sitting in your living room calling everyone you know. your friends, your neighbors, your nephew. that classmate you haven't spoken to in years, making sure they all know how to register and vote every year in every election. this is the movement of our era. protecting that fundamental right not just for this election but for the next generation and generations to come. because in the end, it's not just about who wins or who loses
1:45 am
or who we vote for on election day, it's about who we are as americans. it is about the democracy we want to leave for our kids and grand kids. it is about doing everything we can to carry on the legacy that is our inheritance not just as african-americans but as americans, as citizens of the greatest country on earth. [applause] as you all know very well, continuing to uphold our legacy requires constant, sustained struggle and hard work. it requires never-ending patience and determination. but here's the thing. when you get tired, and you will , when you start to get discouraged, and you will, i just want you to think about the members of this caucus. i want you to think about congressman dellums sitting
1:46 am
cheek-to-cheek with congresswoman schroeder and legislating like he owned the place. and congressman stokes how he went from a soldier in a sfwated army to a senior administrator overseing funding for veterans across this country. [applause] and finally i want you to think of a photo you may have seen in the west wing of the white house. it is a picture of a young black family visiting the president. he brought his staff and two young sons to meet my husband. in the photo, barak is bent over at the waist, and one of the sons, a little boy, just about 5 years old, is reaching out his tiny little hand to touch my
1:47 am
husband's head. it turns out that upon meeting barak, this little boy gazed up at him longingly and said, i want to know if my hair is just like yours. and barack replied, why don't you touch it and see for yourself? so he bent way down so the little boy could feel his hair. and after touching my husband's head, the little boy explained, yes, it does feel the same. [applause] now every couple of weeks, the white house flaffers change out all the photos in the west wing except for that aone. that one and that one alone has hung on that wall for more than three years. so if you ever wonder whether change is possible, i want you
1:48 am
to think about that little black boy in the oval office of the white house. touching the head of the first black president. [applause] and as we mark the 150th anniversary of the emance -- emancipation proclamation, i want you to remember the house my family has the privilege of living in, that house was built in part by slaves. [applause] but today, see the beauty is, children walk through that house and pass by that photo and they think nothing of it because that's all they have ever known. understand that they have grown up taking for granted that an african-american can be president of the united states
1:49 am
of america. now isn't that part of the great american story? isn't it? [applause] it is the story of continuous breathtaking progress from one generation to the next. the story of unwavering home hope grounded in unyielding struggle. it is the story of men and women who said to themselves, i might not fulfill my dreams, but if i march, if i stand strong on this bridge, if i endure another night in this jail cell, then maybe my children will fulfill their dreams. maybe my grandchildren will. it is the story found in scripture in the verse of hee bruise that says "all these people were still living by faith when they died. they did not receive the things prom promised, they only saw them and welcomed them in the distance." so through all the many heartbreak and trials, all and
1:50 am
the many that came before you, you have kept the faith. you could only see that promised lapped from a distance, but you never let it out of your sight. and today, if we are once again willing to work for it, if we're once again willing to sacrifice for it, then i know, i know that we can carry on that legacy. i know that we can meet our obstacle gages to continue that -- obligations to continue that struggle, and we can finally fulfill the promise of our democracy for all our children. thank you, and god bless. [cheers and applause] ♪
1:51 am
1:52 am
>> see the first of the presidential debates wednesday october 3, live on c-span, c-span radio, and watch and engage. next a debate on medicare advantage program. next, richard cordray, and after that, "q & a" with neil barofsky. tomorrow the economy and jobs are the focus of the panel featuring economic advisors from presidential campaigns. jeffrey leiberman speaks for the obama campaign. watch it live 2:30 eastern on c-span.
1:53 am
>> today millions of students are paying less for college because we finally took on a system that wastes billions of taxpayer dollars. removing banks and middlemen, we said let's give this directly to ser advance, and we have been able to help young people in education. >> we have got to make sure that our workers have the skills they need for today and that our kids are getting an education that will allow them to compete tomorrow. that means it is time for us to put the kids and their parents and the teachers first, and the teachers union behind. its interests are very different. >> the first debate between presidential candidates mitt romney and barack obama is less than two weeks away. wednesday, october 3, news hour's matt lauer moderates. watch and engage including our debate at 9:00, and post debate,
1:54 am
calls, e-mails, and tweets. follow our coverage on c-span, c-span radio, and online at c- health care industry experts testified friday before the house ways and means subcommittee on health about funding cuts to the medicare advantage programs under the affordable care act. among the witnesses, president and c.e.o. of america's health insurance plans, and james cos grove with the government health accountability office. this is an hour and 15 minutes.
1:55 am
>> as you know, we will be hearing votes as expected. to hear the witnesses' testimony, i ask unanimous consent that my opening statement be made part of the record. without objection, so ordered. i would also ask that we do -- that if we do get interrupted by votes, i ask the members to return so we can finish questions. also, before i recognize ranking member stark for the purposes of an opening statement, i ask unanimous consent that all members' written statements be included in the record without objection, so ordered, and i know recognize the ranking member for five minutes for the purpose of his opening statement. >> mr. chairman, i ask that my opening statement be made part of the record. >> without objection, so ordered. >> today we are joined by six witnesses, james cosgrove from
1:56 am
the health care group at the government accountability office, james cabretta from the economy sector, and the president and chief executive officer of america's health insurance plan, dr. kim swong, medical director of scan health plan, john tallent, chief executive officer, and marcia gold, senior fellow at mathematics policy research. mr. cosgrove you are now recognized for five minutes. >> good morning, chairman herger and members of the subcommittee. i am pleased to be here as we discuss medicare cost plans which offer medicare beneficiaries an alternative to the service program. for many years private health plans have played an important role in benefits for beneficiaries. currently 36 million medicare
1:57 am
beneficiaries, one in four, receive their health care from such plans. today i would like to discuss our recent work in three areas related to medicare health plans. let me start by summarizing our work on quality programs for m.a. plans and c.m.f. demonstrations. we would like to foster high-quality health care, for plans that achieve high quality rating. however, instead of implementing these provisions, c.m.s. implemented the quality bonus payment. this three-year demonstration makes recipients eligible, increases amounts, and phases in bonuses. it is expected to reach $8.3 billion, an amount seven times larger than that of any other medicare demonstration offered since 1995. the bonuses are expected to
1:58 am
offset 70% of plans this year and about a third of reductions next year. due to the design of the demonstration, most of the bonuses are paid plans of average quality. the intention is to test whether the demonstration's approach would encourage plans to adopt more quality improvements. however, we believe that more serious demonstrations cast doubt on its ability to produce meaningful results. in march of this year, we recommend that h.h.s. can sell the demonstration and allow the quality bonus payment system to take effect. h.h.s. did not agree with our notification. it also gave rise about the agency's ability to give payments. the statute does provide broad authority. however, in a july 24 letter to the official at h.h.s. we found the agency had not established the criteria needed in the statute. next i would like to discuss our
1:59 am
most recent report which designs plans recipients duly eligible for medicare and med -- medicaid. threes plans were originated to help people navigate the two very different health care systems and a pay appropriate to their needs. it does appear that these provide a payment package that may be more needed to the needs of duals. however, c.m.s. has not required these to report information with you but could better hold plans accountable. we found little available information on the amount and appropriateness of the plans and care these plans actually provide. further more, we found the plans did not meet standardized performance measures when reporting information on outcomes for c.m.s., making it difficult to repair these and hold accountable results. we concluded there was
2:00 am
insufficient information on how these plans are meeting the needs of duel -- dual recipients. we ensured they have what they need to monitor performance. h.h.s. can be inferred with these recommendations. finally, i would like to share some of our findings related to medicare cost plans. cost plans have been a part of the program since the 1970's. we found these man's had higher operating scores than any plans. these plans have been in a relatively small number of states. there were 20 contracts with cost plans and enrollment was just under 4,000. however this represents a 36% enrollment increase since 2009.
2:01 am
while cost plan enrollment is small compared to m.a. enrollment, they told us the cost player requires a plan in areas where people have had few or no m.a. plans. .
2:02 am
>> the hmo plan affected 95% of costs. it is clear that hmos that have by far the largest enrollment numbers, 11.4 million as of february 2012, have built capacity for many years to deliver care more efficiently than fee-for-service. they should not be surprising. medicare fee-for-service is highly inefficient and undermine scored nation. -- undermines coordination. the differences of quality for the programs is admirable, but it would be even greater if fee- for-service was rated in the same metrics. the united states continues to
2:03 am
experience difficulties with health care delivery systems. recent studies have left little doubt about this fact, but medicare fee-for-service is part of the problem. it is a dominant player in many markets, and it has become the default option for many payers. the theory -- sheer size insures the entire delivery service is organized around it. those looking for the reasons why we have too much fragmentation and lack of coordination and low-quality care in too many settings should look no further than the incentives imbedded in medicare fee-for-service. my second point is that the reductions contained in the 2010 healthcare lost -- a law will raise costs for seniors and force many out of their plans. according to the congressional budget office, the total cut in 2010 is estimated at $308 billion. hundred $6 billion in direct cuts.
2:04 am
when hundred $6 billion in -- $106 billion in indirect cuts. the impact is indisputable. according to the most recent trustees' report, enrollment in ma will peak in 2013 and then fall in 2017. further, by law, plans must provide some percentage of the difference between their cost and the benchmark to beneficiaries in the form of expanded benefits, and thus reducing payments will reduce benefits in those currently enrolled. in a steady eye coauthored for the heritage foundation, we estimated this would be $3,700 by each enrollee by 2013. why has this crown in 2012 and 2013? the answer is relatively simple. cuts are back loaded. through 2013, less than 10% of scheduled reductions of gone
2:05 am
into effect. costs have risen modestly because of the slow economy. more importantly, they have sent an unprecedented and perhaps unlawful $8.30 billion of plans, filling in a 70% of cuts in 2012 alone, quite plainly because the agency wants to mitigate the impact of cuts required by law. there is no abidin explanation for what is going on in this particular demonstration program. there is no public policy rationale to justify it, as the testimony from various government agencies have indicated. once this is terminated, as it inevitably will become a plan to be forced to pare back benefits and in rahman and plans will drop. my third point is that plants are particularly important for lower income seniors. cuts will hit this population the hardest. lower income seniors are disproportionately represented in these plants. premiums are usually well below
2:06 am
the cost of coverage. in the study i co-authored, which i previously mentioned, we used earlier findings to estimate the beneficiaries of incomes between $10,800.21000 $600 or 19% more likely than the average beneficiary to enroll in the average plan. ma can provide innovations in with the medicare fee-for- service cannot. the program insures some level of choice of beneficiary, which is important for program accountability. if we want delivery system reform, and i think we do, the program is something to be built upon. thank you. >> thank you. recognized for five minutes. >> thank you mr. chairman, ranking member. we appreciate the opportunity to testify on behalf of the program that serves 27% of medicare beneficiaries. a testimony focuses on three
2:07 am
things. first, the specific programs we implemented to improve the effectiveness of care. second, the body medicare advantage plans bring. third, the impact of future cuts and a new premium tax that begins in 2014 carried health plans in medicare advantage, as well as serving employers an individual person -- individuals, our partner and to make sure to change the way care is paid for by paying for the effectiveness rather than services delivered. we're looking to change what is service spite -- purchased by rewarding successful outcomes and implying other strategies to make sure patients receive the right care in the right setting. health plans offer customized programs and support services that are integral to avoiding hospital readmission and reducing emergency room visits. also addressing health-care disparities, providing personal health records. these programs and tools have
2:08 am
been validated in pure reviewed journals. these also help patients receive the appropriate amount of services post discharge, including follow-up calls from nurses to make sure patients understand the drug therapy, there be a delay shouldn't -- rehabilitation needs, and when they should follow up. this also follows instructions on how to use any medical and equipment necessary at home. they are coordinated to help patients with multiple chronic conditions navigate an increasingly complicated delivery system, as well as partnering with clinicians by supporting their of the -- ability to do complicated management and improving the quality of care by providing data about variations of care, best practices, and efficiency of treatment. call plans to buy valley to beneficiaries by providing strong consumer -- bring the value to beneficiaries by providing strong value and project -- protecting
2:09 am
beneficiaries against unpredictable costs and establishing plans that encourage them to give the preventive care in need and providing a more organized support system for those with chronic illnesses. the partner with the plans with a variety of initiatives to expand these tools. we believe that these partnerships hold great promise. two days ago, the centers for medicare and medicaid services announced information about the high quality affordable health plan choices that will be available in 2013, and the medicare advantage program. this announcement is good news and clearly demonstrates that medicare advantage plans have been successful in delivering volume to beneficiaries. looking forward, we are concerned about the impact of the future cuts to the medicare advantage program. are britain testimony presented data from the congressional budget office. i will not repeat those data, but given the scale and scope of these reductions over the next few years, and since the majority of the reductions have
2:10 am
not taken effect, we are seriously concerned about the potential impact. in addition, another element to this and to the scaling of the impact of potential reductions is that it is going to be compounded by a new premium tax scheduled to begin in 2014, which will amount to $220 per beneficiary in 2014. forepart d plans, the premiums will increase by an estimate $9. given the size of the medicare funding cuts and the new premier and tax, if across-the-board sequestration cuts are triggered under the budget control act, it could have serious impact on beneficiaries and place a financial burden on clinicians' participating in the program. medicare health plans will continue to do everything they can to preserve benefits and keep coverage as affordable as possible for the millions of seniors and people with disabilities they serve. however, given the size of these
2:11 am
cuts, along with the impact of the premium tax, we are concerned in the coming years of the potential for medicare advantage beneficiaries to face higher costs and coverage disruptions. we look forward to working with the committee to address these concerns and preserve medicare advantage for future generations of beneficiaries. >> thank you. recognized for five minutes. >> thank you chairman, ranking members, members of the subcommittee. i am chief managing officer of scan health planning in at long beach, california. i am board certified in internal medicine and have been working for 25 years. i appreciate the opportunity to appear before you to discuss the innovative programs that stand is put in the other to meet the needs of our most vulnerable and -- has put in place to meet the needs of our most are members. we will focus on our special needs plants. they serve medicare
2:12 am
beneficiaries with highly complex health needs. there are three types. first, institutional plans serve individuals who reside in institutional settings or who live in the community but require institutional level of care. largestthe nation's community-based planned. second, chronic plans, serving individuals living with mauve or chronic conditions. we have one that focuses on in a state training locuses. third, the dual-eligible plans that serve a dual-eligible beneficiaries. we run in california costs only fully eligible plan. we serve 16,000 individuals in a special needs plans. in addition, the health plan is the nation's third-largest not- for-profit medicare advantage plan. we were founded in 1977 by
2:13 am
senior citizens in long beach who were worried about the prospect of declining health in the economy. these citizens helped to design a program providing extra services and supports to keep them living in their own homes and not in nursing homes. since then, we have caught nearly 100,000 individuals avoid or postpone a nursing home stay. when special needs plans came along in 2006, they reflected scan's mission to help seniors maintain hope -- health and independence. ideally, the model was the same, placing the beneficiary of the center of care. it was a natural transition to move for -- to continue with their personal care plans, care transition's assistance, disease management, and medication and therapy management. this model can significantly improve how far comes and bring
2:14 am
down the cost of care -- health outcomes and bring down the cost of care. let me give you an example. in april 2012 study found that hour duel eligible members had a hospital readmission rate that was 25% lower than dual eligibles in medicare fee-for- service with identical risk profiles. the study also found that scan performed better than fee-for- service on the prevention quality indicators overall, keeping people out of the hospital to begin with. keeping people out of the hospital saves money. these are the results of a match cohort analysis of california fee-for-service duals who had the same hospitalization and readmission rates. this would result in a least $50 million in annual savings to medicare fee-for-service in california. studies are used for, but let me
2:15 am
give you a real example. a native spanish speaker recently enrolled in a scan program. like all enrollees, he filled out an initial held assessment. in it, he revealed that over the last few weeks he felt down, depressed, or hopeless more than previously. the case manager was able to reach him and perform an assessment. the manager identified concerns -- depression and suicidal ideation, poor relationships with primary-care physicians, and inadequate access to needed psychiatric care. the assessments for shared with the pcp, and a behavioral health specialist recommended partial hospitalization. they partnered with medical groups to coordinate services and aggress language-related barriers. they connected him with a spanish-speaking psychiatrist who knew pcp. today, he has that new pcp and
2:16 am
is visiting his psychiatrist regularly and is no longer having suicidal ideation. the model of providing patient- centered coordinated care too vulnerable populations has been a success. unfortunately, the authorization is set to expire at the end of 2013. congress should act as soon as possible to renew them for at least five years. moving quickly is imperative. plants must file their notices to offer these plans for 2013 by november of this year. a multi-year extension would provide stability to beneficiaries to ensure that beneficiaries to not experience a dangerous lapse in care. my recent testimony includes a number of other recommendations to strengthen these programs to give beneficiaries better care. people who are frail, disabled,
2:17 am
and -- >> if you could conclude -- >> they are poorly served by of fragmented models. we ask that we let -- you that these programs continue to work. >> thank you very much. >> chairman, ranking member, distinguished members of the subcommittee, my name is john talent. i am the chief executive officer of medical associates health plans in dubuque, iowa. i am testifying on behalf of the medicare cost contractors alliance, a coalition of 15 medicare cost plans that serve more than 400,000 medicare beneficiaries enrolled in plans in 14 states and the district of columbia. since 1972, they have proven to be a stable, quality alternative to medicare fee-for-service, particularly for beneficiaries living in rural areas and areas in which risk-based plants have
2:18 am
encountered challenges. we firmly believe that medicare cost plans should remain available as a coverage often, and are grateful for the bipartisan support the program has enjoyed. we want to thank representative paulson and rep kine for introducing legislation to preserve this important program. there are 19 medicare cost plants across the u.s., located principal early -- principally in rural areas or areas with low advantage rates. 90% on non-profit organizations. a large portion of plants are owned by or affiliated with well-regarded medical groups. the average cost plan has been providing high-quality, cost- effective services to medicare beneficiaries for over 20 years. for nearly three decades, medical associates health plans has been serving medicare beneficiaries under a cost-based contract in five counties in iowa, four counties in
2:19 am
wisconsin, and one county in illinois. like most plants, our members are elderly. the average age is almost 76. one-third of our members are 80 years of age or older. in fact, many of our members have been with us for 20 years or more. our members like a plan, and we have less than 1% voluntary disagreement. medical associates health plans is owned by medical associates clinic, the oldest multi- specialty group practice clinic in iowa. we are proud of the quality services that operate -- we provide to our members. in 2012, medical associates health plan was one of 12 contracts out of 569 that received a five-star rating. our wisconsin plan receive before. five-star rating. if current law is not changed, over 230,000 beneficiaries will lose their cost plan coverage in 10 states on january 1, 2014.
2:20 am
medical associates would be forced to withdraw from four of the five counties in the i will service area. this is despite the fact that medical associates is overwhelmingly the most popular medicare health plan in our service area and has the highest quality rating as well. in states like texas and south dakota, cost plans will have to withdraw from rural areas, despite a very low medicare advantage penetration. members throughout minnesota and portions of minnesota, colorado, and ohio will lose their plans. because of the withdrawals, these honorable beneficiaries will face higher costs. they could also face disruptions in longstanding provider relationships, since many of them have been medicare cost members for many years. as you know, medicare advantage rates are scheduled to decline under current law. history shows that when payments diminished, clients withdraw from the program or reduce their
2:21 am
service rates, causing many to lose their choices, particularly in rural areas. to prevent 230,000 medicare beneficiaries from using the medicare cost plan choice in 2014, and to ensure the beneficiaries have an ongoing choice of quality medicare and managed-care plans, it is imperative that congress pass legislation this year. we very much appreciate the opportunity to testify before the subcommittee and look forward to continuing to work with members of this committee. thank you. >> thank you. chairman, ranking member, members of the subcommittee, i am a senior fellow at mathematical policy research, an independent, nonpartisan public policy organization. i want to make seven points that i will elaborate on in my written remarks. first, the ma problem today is strong, with rising in rahman
2:22 am
that is expected to continue into 2013. well the aca sought to scale back payments to achieve closer alignment of penh -- payments made for beneficiaries of the ma versus the traditional program, it was acting in line with the origins of the program according to the recommendations of congress's non-partisan advises. it will also extend the life of the medicare trust fund for all beneficiaries. second, ma plans are still paid considerably more for similar beneficiaries than traditional programs. in considering future policy change, it is difficult to see rationale on a national level -- basis for paying private plans more than medicare currently spends on the traditional program. particularly when there is so much concerned that the federal -- about federal deficit and debt. although some suggest otherwise, i have studied his plans for
2:23 am
more than 20 years, and there was no strong or consistent evidence that private plans in general are better at cost control than traditional areas, or that competition will produce enough savings to address current fiscal concerns. fourth, polls show traditional medicare remains popular with beneficiaries. that means that paying more for private plans is effectively a tax on their choice. the. d premiums will increase with no benefit to them. clearly, payment reduction at some point could discourage plans from for dissipating, but we are not there now. even if we were, the question is how much payment is warranted to preserve choice, especially if it is cost rather than saving money. overpayments also involve a substantial transfer of funds from government to private firms, if you of him dominate the market. the congressional budget office
2:24 am
has concluded, medicare premium support programs have reduced government contributions to medicare and will shift costs to beneficiaries and limit the health and financial protection the program provides too vulnerable beneficiaries. mahas a role for private plans, but it is not a voucher or premium support program. the defined benefit medicare provides differs fundamentally from a fixed contribution plan. although prince of proposals very, most would fundamentally change the way the medicare program operates and somewhat eliminate traditional medicare altogether. six traditional -- medicare has served as a valuable protection to beneficiaries. it provides defined and national uniform benefits to all medicare beneficiaries. some proposals say that they maintain a traditional medicare option, but they do not appear
2:25 am
to finance it. this arguably presents false assurance about the future availability of traditional medicare as we know it now. the program will be different and beneficiaries would pay more. our health-care system is very inefficient, but traditional medicare and private plans are like this challenges in containing costs. fundamental reform of the system to reduce costs ultimately cannot be achieved without someone paying the price, whether that is the beneficiary, the provider, medicare, or some combination. one person's waste is another's income. it is also not that easy to define medicare and unnecessary care, especially at an individual level. the managed-care backlash showed that policy makers should not expect the private sector or beneficiaries to engage in battles for -- from which they themselves want distance. medicare beneficiaries already paid considerable amount out of pocket for health care, as my
2:26 am
written met -- testimony indicates. other program show that strong oversight and risk adjustment are important to unfair marketing practices and the protection of honorable medicare beneficiaries. when they are absent, scandals occur in people are hurt. appropriate risk adjustment is critical, and all these will be more important as more are eligible to enter the program. in closing, although decisions about the future of medicare will inevitably reflect the values considered socially acceptable by a variety of stakeholders, the evidence suggests there are no easy answers to the fiscal dilemmas facing our nation. thank you. >> thank you. mr. cosgrove, i read in your report that the cmf ma quality demonstration will cover up nearly 1/3 of obamacare cuts to
2:27 am
plans over the life of the demonstration. is this correct? >> the demonstration would offset by one-third the cuts, yes. >> can you please breakdown your estimate of how much of the cuts will be offset each year? >> this year, in 2012, just over 70%. next year, in 2013, about 1/3. in the final year, about 16%, i believe. >> it seems to me the administration is trying their hardest in using any means necessary to hide these cats thesecuts until after this election. ms. ignati, as you know, obamacare's cuts to medicare advantage are real, especially to the beneficiaries that are enrolled in these plans. in fact, not too long ago, cuts to the medicare health plans which were far less than the billions of obamacare resulted in millions of seniors losing
2:28 am
access to their health plans. in some counties in northern california, the district represent, seniors lost all choice of private health plans after the 1997 cuts. even the medicare actuary's highlight these facts in this year's report, which stated that "as a direct consequence of the plan termination, the percentage of medicare beneficiaries who enrolled in private health plans declined each year, from 2000 until 2004." will the cuts to medicare advantage and obamacare not have a real and lasting impact on seniors and their access to the ma plan they have and like? >> to comments, sir. one, with respect to the past,
2:29 am
which are remember very vividly, the lesson there was that congress responded by putting additional resources targeted toward specific counties. in northern california is an example, in the upper northwest and the middle parts of the country. michigan, ohio, illinois, upstate new york. that had a very positive effect. it was a bipartisan action. with respect to what is going to happen as a result of the cuts that we see in aca, and also the premium tax, which has not been focused on what needs to be because it begins in 2014 and compounds this, i cannot tell you exactly what will happen, but i think the cbo estimates provide a window into that. we provided that in our testimony. >> thank you. i understand that scan health has had a fully integrated health plan for beneficiaries, many of them will eligible for
2:30 am
over the last 20 years. can you describe how the plan integrates benefits between medicare and medicaid? >what are the benefits to this type of integration? >> scan has had a program that, for some of our members, we had a contract with the state of california to provide all medicaid or medical services. from member standpoint, all benefits are arranged through the health plan, whether it is medicare benefits, medical benefits, and included in the medical benefits are the home and community-based services and nursing-home care as per the medical program. the way we integrate that, primarily, is through and case management program, a one-on-one relationship with the member or in conjunction with the primary care physician of the medical
2:31 am
group contract with. >> thank you. mr. stark is recognized for five minutes. >> thank you, mr. chairman. i think the panel for their testimony. ms. gold, my republican colleagues who would like us to believe that the sky is falling in terms of enrollment and benefits, premiums -- by these projections, they have turned out to be incorrect. since the passage of the aca, medicare advantage in rahman has increased. the premiums have a decrease. is that not correct? that thisure happened last year. so that this is a one time
2:32 am
event. this is a trend. could you just discussed for a moment the distinctions between medicare advantage to the romney-ryan voucher or premium support program the republicans would have us -- how do they differ? >> there are so many plans still floating around, that i will answer generally. basically, under medicare advantage, beneficiaries always have the option to return to medicare, traditional medicare. they did the same benefits in medicare advantage, whether they are in medicare advantage or traditional medicare. plans are required to pay those. they have a national medicare program and strong oversight. under a premium support program, most of them, and again they will differ, but they do not
2:33 am
guarantee a certain amount of money. there is more with a room in the benefits. a lot of them would seem to dismantle the traditional medicare program into a bunch of smaller programs or changes that make its bargaining power nationally much more limited with providers. >> also, there are some that would like you to believe that the only reason we are still in ma is because of the quality bonus program. i think that most of our residents show that the affordable care act has reduced medicare advantage overpayments by 156 billion doris, as listed -- 100 today $6 million, as listed in the ryan budget,
2:34 am
over 10 years. the demonstration is a total of $8.5 billion over 10 years. is it not also true that the underlying quality program will continue in perpetuity under the law? >> yes. it is in the la. >> so it is possible that the demo is being targeted at the plants to help them improve before this bonus plan takes over? >> yes. >> thank you very much. >> thank you. mr. buchanan is recognized for five minutes. >> thank you, chairman, for holding this important hearing today. i would like to thank all our witnesses for taking the time today to do this. i represent in my district in florida about 200,000 seniors. they obviously rely heavily on medicare. 40,000 of the seniors are on medicare advantage. i want to make sure they have quality health care. millions of americans are
2:35 am
struggling, especially living on fixed incomes. i read a new study in terms of the cuts they are talking about, $716 billion of cuts in the new health turlock, $2.2 billion -- care law, $2.2 billion will be in the district of represent. the question i have, how big will be the impact in terms of our congressional area? mr. talent, can you express your concerns on this, your thoughts on this? >> i apologize, but i do not understand the particulars of florida and your situation. >> just look at the $716 billion cuts. it will be applicable to a lot of different congressional districts around the country. i have 200,000 seniors. $2.20 billion of those cuts will be in the area i represent.
2:36 am
i was just wondering, do you have a thought on the impact of those cuts? >> specifically, i am focusing this morning and have been asked to focus on the affect of -- of --effect >> medicare advantage? >> of the situation we are -- >> let me clarify. you have any comments on that, in terms of the cuts? >> the cuts are going to force small plans to operate more efficiently and effectively, i think. some of the things that the plans are looking for are, how do you use technology more efficiently to care for people? ultimately, cuts will
2:37 am
potentially reduce the amount of benefits, if the cuts are deep enough, but the other thing that helps as we move more towards risk adjustment so that you pay appropriately for the appropriate needs of that individual, that can help offset some of the impact of the cuts. >> do you have any comments on that? >> there is no way to know with precision exactly what will happen in any particular area, but i do think that, looking at what happened in the past, after the budget act of 1997, there is reason for caution and deliberation, in particular i think that as we see the cuts, they are back loaded so we have not seen the impact yet. number 2, the premium taxes going to be extremely -- hitting
2:38 am
in 2014 as these cuts start. that is the place to start for real deliberation in terms of the impact of all these things. without a doubt, i think that our plans are going to do everything they can to maintain benefits and serve seniors who are depending on them. the scale and scope of the -- cuts yet to come is something we are concerned about. >> thank you. >> mr. kind is recognized for five minutes. >> i want to thank our panelists for their testimony today. this is yet another hearing we are having about what is happening with health care reform, which i think is totally necessary and appropriate to have these conversations and find out what is working and what is not, and hopefully have the ability as a congress to continue to make adjustments as we learn more. i do not think anybody going into health care reform, certainly those of us who supported the affordable care act, would think it would be easy or it would happen
2:39 am
overnight. it is quite frankly going to take the effort of the nation, not just one party, to reform health the center -- system in desperate need of reform. i've been one of the leading voices to reform how health care is delivered in this country. especially, we need to change the way we pay for health care so it is outcome-based and the lager volume-based payments. -- no longer volume-based payments. and the plans to represent have benefited a lot when it comes to these reforms. we need to have parallel path between medicare and the private plans out there. doing it in isolation is not going to work. could you give us a quick update on what we're seeing, especially in the private sector, with these kinds of delivery and payment reforms that are happening? >> i appreciate the opportunity to do that. there are very significant changes going on all across the country that are very exciting. the story is about collaboration
2:40 am
-- health plans and clinicians' collaborating in a patient centers and medical homes to bring more value and case management to those who have chronic illnesses and putting the strategies into medicare advantage and medicaid plans and so on. i think that shows real promise. two, bundking, -- bundling, changing to a prospective payment rather than a rustic retreat. we are beginning to see a retraction as a result of that all across the country. the third point, i mentioned that in my oral remarks, we are partnering with cmf on a number of initiatives. that also holds promise in terms of getting more traction and getting more pick up across the country in a synergistic way. i think you'll be hearing more about that. without a doubt, what is very significant now as a result of these strategies -- help plants are showing. journal that said that they are working with respect to
2:41 am
remissions. -- pure reviewed journal data that says they are working with respect to remissions. we will have to have more courtney to care and partnerships between plants and clinicians and hospitals -- more coordinated care between partnerships and plans and clinicians and hospitals. >> how will they fare over the next three years as far as bonus payments are concerned -- what i do not understand, there are two competing visions of where health care reform needs to go. under the romney-ryan plan, the changes they are advocating what happened in 10 years from now. i am sorry, but that is not good enough. we cannot sit iran and we 10 years before we make important decisions -- sit around and wait tenet years before we make important decisions. there is some criticism appear on the dais today about how these plans will be reduced and the impact it will have on
2:42 am
medicare advantage plans, but would it -- once the plants -- to begin with in 2003 and passed in 2004 as part of the medicare modernization act and the new prescription drug plan? is that right? is that replants came from? >> yes. there was a predecessor program referred to as the risk program, which went back to the 1980's. the program built upon that. >> do you recall sitting here today whether that legislation passed that also called for a higher reimbursement levels for ma plans, whether any of that was paid for in the 2004 bill? >> i do not. >> the answer, and i think everybody on the dais understands, it was not. was a major piece of legislation, the largest expansion of entitlement spending since medicare was created in 1965, and not a nickel of it was paid for. many of us at the time who voted against it did not think it was fiscally responsible to the offering is higher reimbursement payment to ma plans without any
2:43 am
ability to pay for it to begin with. now we hear criticism we are trying to reform that and find cost savings, cost savings that were completely adopted in the ryan budget, and virtually every single one of my colleagues voted for it. now they are trying to have it both ways here, which is inexplicable to me. i think you testified about the different -- difference is that there are between their plan, which would privatize or voucher or print support or whenever you went to college, the existing medical are -- medicare program. is there an important distinction to be made their? >> the gentleman's time has responded -- expired t. maybe you could respond in writing, please. >> thank you, mr. chairman. mr. cosgrove, in your testimony before the government reform committee in july and again
2:44 am
today, even though cmf enacted a demonstration seven times larger than any since 1995, > the -- combined budgetary effect of the demonstration and has no control group to judge the outcome of the demonstration program and insofar as to suggest to the demonstration should be cancelled -- is that right? >> we did recommend that the secretary cancel the demonstration. >> ms. ignani, president obama, during the large discussions around the passage of the new health-care law, made much of the argument that if you like or plan, you'll be able to keep it. can you reflect on how the reality is of what your members are dealing with in their ability to offer products that existed before the enactment of the health care law, and what they are dealing with now? >> first of all, in the medicare advantage irina and the commercial arena, we are doing
2:45 am
everything we can to break costs down and improve quality. that is what beneficiaries and purchasers one. as we look at the cuts with respect to aca in medicare, we are very concerned about the future impact. we will continue to do everything we can to bring costs down and improve quality, but if you look at the scale and the size of these, plus a premium tax, that adds and compounds the impact. we are very concerned. the data we provided from the cbo gives you a window into the potential effect. the honest answer is that we do not know what the future will hold. we will work very hard to do our part, but as we see the size of all this, it will come into effect, we're very concerned. >> you have said concerned two or three times. let me focus on mr. cabretta. if your advising ms. ignani on
2:46 am
the nature of her concern, if you are there looking out over a spreadsheet and making some predictions, what are the things that she needs to be concerned about is the stated goal of the president of the united states is to be able to offer a program, continue to offer a program that somebody currently enjoys? >what would you advice about the nature of the concern going forward? >> she needs no advice for me, first of all. >> will play. >> it is quite clear from the trusty projections that the program will shrink. the question is the degree and magnitude. the law requires that any payments above a bid but below the benchmark are returned to the beneficiary in the reform -- a form of higher benefits. when you reduce the payment, by definition they will scale back
2:47 am
what they can offer the queue that is a truism, right? that is not a revelation. -- that is not a revelation. the trusties project that one- third of the program will disenroll one way or the other. they plan to close down some of the county's they are operating in, or some beneficiaries will disenroll voluntarily because benefits to be less attractive. in five years' time, trusties assume the program will be basically one-third smaller than it is today. >> for the congressman from florida, he has 200,000 beneficiaries, 10 or 12 or 15,000 beneficiaries will probably lose the land they have today and move back to the traditional program. i do not view that as a very positive development. it can be an important program, but let's recognize it is not coordinated care.
2:48 am
it is fragmented care that is not necessarily deliver higher quality care. there is no matter to prove that. >> your testimony is that the trustees, the people calling balls and strikes on this, say that in a period of six years, a third of the beneficiaries are going to be out of the system, and is your conclusion that one-third leaves because of the downward pressure on reimbursements? either they take themselves out, the beneficiaries do, or the carrier is no wonder our part is bidding in the program, is that right? >> that is correct. slightly less than one-third. those of the reasons why. >> i yield back. >> recognized for five minutes. >> thank you, mr. chairman. i will continue this line of questioning that mr. roskam was pursuing with mr. cabretta. to clarify, when the bill was
2:49 am
first drafted and passed, we were looking at a $523 billion cut to medicare. $200 billion of that was medicare advantage. today, cbo has increased that figure. is that correct? >> that is correct. >> i am really confused as to what we are supposed to believe. the other question, and mr. ross and -- roskam touched on that, is that the president has said, if you like for health care plan, you can keep it. but the president came back and said that when he was asked about that question, there may have been some language inserted in that bill that runs contrary to that premise. that is a paraphrase of his comment. what are we supposed to believe,
2:50 am
is still my question. your testimony suggests that the cuts to medicare advantage may force seniors to lose a plan they like and -- give up a plan they like and currently have. is that true? >> that is true. >> than they are forced into less preferred options like the four services, or less generous medicare advantage plans? >> that mr.. >> so let's talk about the seniors -- that is true. >> -- so let's talk about the seniors. is it not true that they expect millions of seniors to lose advantage to medicare advantage altogether? >> i could not specify exactly how it is likely to fallout, but you could surmise that there are about 4 million fewer benefits serious in all of medicare advantage in 2017 than there will be in 2013. of those 4 million, one might surmise some our intent is for the have pulled out. others are in counties where the plants are still there operating but operating less generous
2:51 am
benefits. perhaps it find a less attractive and move back into fee-for-service. the reason for this rahman is not clear yet, but -- >> there will be to some ii there will be. >> they will not be able to keep -- there will be disagreement. >> there will be. >> so they will not be able to keep their plan of the electorate seems to stay will be peak yes theyts to th will. >> said bill before us back to fee-for-service medicare which is not coordinated -- so they will be forced back to fee-for- service medicare that is not coordinated. >> that is true. many of them may try to buy gap insurance, of which the average prison is $150 a month. >> that was my next question. chairman herger and i have been doing investigation into medicare and aarp and its involvement in helping to negotiate this obama health care
2:52 am
plan. i find it interesting that the promises made -- you can keep your health care if you like it, aarp, they benefit from this. as they leave medicare advantage, what happens is, fourth aarp, they end up with a $1 billion windfall over 10 years. they create their revenue by $1 billion. in 10 years, as a result of that change. because it aarp gets a flat rate fee for medicare advantage seniors. they get a percentage of every senior enrolled in medigap. i find it curious that in this bill we will tax the people who do not buy insurance. we will tax medical devices. we will tax people -- businesses who do not provide enough insurance with a penalty. we will also added $3,000 tax penalty if you provide to much
2:53 am
insurance. we will tax 40% on a cadillac health. we will tax the american citizen over and over again, but aarp, with a $1 billion increase in revenue in 10 years, is a tax- free organization and will not be taxed 1 cent on that $1 billion. i do not expect you to respond to that. i appreciate your time and your back, mr. chairman. >> thank you. ms. black is recognized for five minutes. >> thank you, mr. chairman. i appreciate the panel be here today and helping us to look at what the future of these programs might be for especially the very frail population. given my health care background and having worked in the long term care, i am certainly acutely aware of their needs. one of the things, if i work for
2:54 am
patients over the years, they still want choice. they want to make some of those decisions and not feel like they will be told about everything that is going to be done for them. i want to turn to you, because i believe that this is an area where we really need to take a look. you have both the classical background and also the background on the economic side of it scan, the special needs program for many years. in your testimony, on page 6 to talk about the special needs model of providing patient- centered coordinated care too vulnerable populations and it has been a success. you say, unfortunately, as we all know, the current special needs program authorization is set to expire in 2013, which is a great concern to me. if you could briefly talk about what you want to see -- if he were to sell this program to
2:55 am
policy makers to make that decision, tell me what you see as being the benefits, then i also want to know from you, what do you see as a possibility of working in the environment of the costs of patient-centered care and quality -- what kinds of things could you do to make the program better and make it more effective? >> to start with, what could you do to make it better? there are three different types of snips, said the answers depend on which you are talking about. the dual snips, one of the things that could be improved is better coordinating and reducing overlap of regulatory issues between the state and federal government. not that one is wrong or one is right, it is just that there is conflict and and there is duplicative work. what you can do for the overall
2:56 am
programs, i think, is recognize that all the snips are people who are very different, whether it is the duals or the chronic or institutional. measuring quality specifically for that population to be a big help. the five-star system is a great step forward in measuring quality, but unfortunately it does not always apply to some of the unique populations out there. what is good for a person on dialysis may not be the same quality metric you want to measure for a person who is dual eligible and not on dialysis. the other thing is that we have shown that providing home and community-base services is very valuable in keeping people in their home, which is where they want to stay, and out of a nursing home.
2:57 am
allowing plans, other plants other than just plantsd-snips, -- just about d-snips, to provide that, would go a long way to preventing people who are low income but not yet on medicaid, to prevent their going to a nursing home and ending up on the medicaid program. >> thank you. >mr. cosgrove, i want to turn to you. i know the gao examined the requirements of the medicare improvement in 2008, which established the contract requirements for the dual special needs programs. can you discuss some of the challenges identified by the state in implementing the contract? >> yes. we met with i think five states to talk about the challenges they face. part of it, they explained, one
2:58 am
of the terms they used was bandwidth. it is just the number of organizations that they would have to contract with, the state having the resources to be able to do it. the agency is more viable for plans that are larger. some of thesnips -- the snips are fairly small. they also brought up some other issues as well, in terms of the state fiscal year may not coincide with the contract in year for them snip, which causes difficulty for them entering into contracts as well. >> you have experienced this particular issue. you have any comments regarding this report? >> the gentle lady's time has expired. if you could answer that in writing. >> thank you, mr. chairman. that would quickly. >> mr. mcdermott is recognized
2:59 am
for five minutes. >> thank you. as i sit here and listen to this, i think about the best political offense to have -- make people confused. a lot of people watching this cannot understand that everybody speaking on the other side, talking about these awful cuts, voted for them. every single one of them voted twice for them. they are trying to have it both ways. is it true that the aca actually eliminated costs and give new benefits to people and is in place now? that truth is bolten. ms. gold? >> yes. >> what is the difference between this voucher plan that the ryan budget oncehis
3:00 am
medical plan? what is the difference? i sit up here as a doctor and think about patience rather than product and numbers and trends and graphs. so tell me, what is going to be the difference for a patient if they are forced into a voucher plan by ryan or remain in the regular medicare? >> it will be a lot more confusing and probably a lot more expensive, depending on how much money congress puts in. right now, beneficiaries' no medicare. medicare is very popular. 70% of beneficiaries remain in m e
3:01 am
3:02 am
3:03 am
3:04 am
3:05 am
3:06 am
3:07 am
3:08 am
3:09 am
3:10 am
3:11 am
3:12 am
3:13 am
3:14 am

Road to the White House
CSPAN September 24, 2012 12:20am-3:15am EDT

Series/Special. (2012) Campaign rallies and analysis on the 2012 presidential race.

TOPIC FREQUENCY Missouri 22, America 20, Washington 16, Claire Mccaskill 9, Iraq 8, Afghanistan 8, U.s. 6, United States 5, California 5, Obama 4, Mr. Cosgrove 4, Mr. Assange 3, Mccaskill 3, Cmf 3, United Kingdom 3, Iowa 3, Washington D.c. 3, Russia 3, Florida 3, Jonathan 2
Network CSPAN
Duration 02:55:00
Scanned in San Francisco, CA, USA
Source Comcast Cable
Tuner Channel 91 (627 MHz)
Video Codec mpeg2video
Audio Cocec ac3
Pixel width 704
Pixel height 480
Sponsor Internet Archive
Audio/Visual sound, color

disc Borrow a DVD of this show
info Stream Only
Uploaded by
TV Archive
on 9/24/2012